Extreme Self Care

I need to practice this today. Last night was a difficult shift with a beautiful labouring woman, for several reasons. I am very hard on myself, in a way I would not want my girls to be hard on themselves. When I find myself beating me up I try to be my own mother. Would I say this to my daughters? Would my own mother say this to me? No. Never. Would I want my daughters to treat themselves this way? No. Absolutely not. So why is it okay to do it to myself?

The answer is that it’s not okay, understandable as it may be. I am a #perfectionist who has enough self awareness to know those tendencies need to be gently discouraged, without always being able to follow through. I have always held myself to very high standards and anything less than a top performance feels disappointing. The truth is I was an excellent midwifery student. Before midwifery I was an outstanding arts student, excelling in my language studies. Academically, I achieve. I have a brain that is wired for it. Clinically, I feel I’m an average, albeit relatively novice midwife, and that is a challenging space to live in for someone like me.

I like being good at what I do. I desperately want to be good at my job. Some days I feel I am. Some days I feel I have no right to be there. Yesterday was one of those days, and I’m sure every other midwife and student midwife has felt this way at one point or another. Those days are hard. Those days can be soul destroying. At one point I just wanted to cease to exist, such was the strength of my shame. If the ground had opened up before me, I would have jumped in gratefully to be swallowed whole.

Sadly, the ground didn’t open up. Instead, I stood tall, and very still, focusing on my breathing while my colleague helped navigate the delicate situation we were in, explaining things to our woman in a very calm, very kind, very affirming way. She had to tell “my” lady that my vaginal exam 2 hours earlier had been inaccurate, and she was not 6cm as I’d reported, but 4 to 5cm. It doesn’t sound like much but it can destroy a woman’s confidence and motivation to effectively be told she has gone backwards, or worse, she’d never progressed so far in the first place. I knew the potential implications of this error were serious. To quote a fellow midwife, “Labour is a mind game”. I didn’t want to be responsible for breaking her spirit.

I stood there silently, just listening, watching, learning. I swallowed my pride and fought the negative self talk to bring my innate sense of self worth to the forefront. My husband’s words came to my mind: Je sais ma valeur. I know my worth. My head was swimming, rewinding through the chain of events and thought processes that had led us to that point. I simply could not believe I had made such a basic, avoidable error in judgment.

Later, my colleague, an incredibly wonderful, very senior midwife, reassured me- “Mia, there are times when even I, after all these years, don’t know what I’m feeling in a vaginal exam.” My eyes welled again as I replied, “Yes. But you and I both know, that that was not my mistake. My mistake was knowing I wasn’t sure and not asking for help when I should have- and not telling our lady that I wasn’t sure.” That was the cause of my shame, not just getting it wrong. She smiled at me very patiently and nodded. “But you’ll never do it again.”

No I won’t. I learned so much in those few hours, and I know my error will not impact the ultimate outcome of her labour and birth. I am so very grateful for this, first and foremost. But now it is time to give myself a break, practice extreme self care and focus on what went well. I believe we must do this every time we take off our midwife hat and put our day’s experiences to bed.

What went well?

The woman was appreciative of her care. When I apologised at the end of my shift for having not given her the correct information at the right time she waved it away saying she wasn’t concerned at all. She had felt safe and cared for. That is worth celebrating.

I was able to be honest, authentic and vulnerable with my senior midwife and with my student. I explained everything to my student, the flawed reasoning for how I’d gotten to that point and how I would do things differently in the future- ie don’t do what I did. Do this…

My student told me that in all her training (she is about to graduate), she has never witnessed a midwife obtain “true informed consent” for an epidural in labour. She appreciated that. She’s referring to the following discussion:

Before our woman’s pain had become too much to bear she’d asked about epidurals. I reassured her that of course we will support her in whatever she feels she needs. She wanted the pain to stop. I empathised. I reminded her of what we’d spoken about earlier, that this is the one time in your life that these feelings are not only okay, they are necessary to bring her baby down and birth is what will take the pain away- instantly. I reminded her that her body knows what to do, and she can do it. She is doing it. I reminded her that despite the intensity of these sensations (is it helpful to call it pain all the time?), she is safe. Knowing she had wanted to be as active as possible during her birth, I explained that while an epidural should take most if not all the pain away, she will still feel pressure (and this is helpful for pushing! It’s hard to push into your bottom when you can’t feel you even have one). I explained that epidurals unequivocally increase her likelihood of needing medical intervention to pull her baby out with a vacuum or forceps, with or without a caesarean section. I went on. She will also be confined to the bed, unable to void herself, and will require a catheter to be inserted to drain her bladder. She will also likely need higher doses of the syntocinon drip which increase the likelihood of her baby getting overly stressed out- and forcing that intervention I just mentioned. On the flip side I said, sometimes, an epidural can be exactly what you need (for your already exhausted body and mind to rest, relax, and surrender to the process). “As your midwife, I just need to know,” I said, “that you are aware of this and are okay to go ahead with that understanding. At any point you do want to go ahead, I will support you.”

She did get an epidural, but not for quite a while, and she did not take the decision lightly. I know she went into it with her eyes open, and because of this, whatever the outcome of her labour, she won’t look back in anger or self recrimination saying “I wish I’d known” or “Why didn’t anyone tell me…”.

Finally, last night confirmed what I’ve long suspected. I care deeply about better outcomes for women, and my greatest strength lies in my passion and enthusiasm for educating and empowering women- before they get to the labour ward. I can’t do that in my current role. Change is in the air and I’m going to run with it and join the #positivebirthmovement.

It’s time.

#midwifelife #studentmidwife #beingbrave #selfcare #itstime #informedbirthpreparation #positivebirtheducation #informedchoice #thosebloodyepidurals #inductionoflabour #empoweringwomen #hypnobirthingaustralia